Computed tomography appearance of ovarian fibrothecomas with and without torsion

Fibrothecomas are the most common solid ovarian tumors and may undergo torsion. Early diagnosis of these tumors is important in order to allow prompt surgical treatment.

To describe the features of ovarian fibrothecoma on computed tomography (CT) and to determine the possibility of detecting tumor torsion in this kind of tumor.

The CT images of 11 patients with ovarian fibrothecomas in the past 8 years at our hospital were retrospectively reviewed. The CT attenuation values of each tumor were measured in both non-enhanced and enhanced scans. The size and degree of enhancement were evaluated and correlated with tumor torsion. All cases were pathologically proven.

Three kinds of tumor pattern were found: 1) homogeneous tumor with significant enhancement containing scattered, low-attenuated regions after contrast injection; 2) heterogeneous tumor with mild enhancement after contrast injection; and 3) low-attenuated soft-tissue mass with no obvious enhancement after contrast injection.

Fibrothecomas usually appear as a homogeneous solid tumor with varying degrees of enhancement. Calcification may be present and, as these tumors enlarge, myxoid or cystic degeneration may occur, resulting in a heterogeneous pattern. The larger the tumor, the greater is the chance of torsion. Lack of tumor enhancement is the most reliable sign for detection of ovarian torsion and should facilitate prompt surgical intervention to remove damaged tissue.